Healthcare Provider Details

I. General information

NPI: 1235599952
Provider Name (Legal Business Name): Y. MALINA, MD, FAAP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 MERMAID AVE FL 1
BROOKLYN NY
11224-2210
US

IV. Provider business mailing address

2426 MERMAID AVE FL 1
BROOKLYN NY
11224-2210
US

V. Phone/Fax

Practice location:
  • Phone: 718-676-2055
  • Fax:
Mailing address:
  • Phone: 718-676-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number235292
License Number StateNY

VIII. Authorized Official

Name: YELENA MALINA
Title or Position: PRESIDENT
Credential: MD
Phone: 718-676-2055